Printed from ChabadPotomac.com

Register Returning Students

Register Returning Students

Returning Students Registration Form

Please note this form is for RETURNING STUDENTS ONLY! If you have never been to our Hebrew School please fill out the New Student Form here.

Student Profile
Family Name
Name of Child #1
DOB
Time of Birth In Judaism the day begins at nightfall, so in order to determine the exact date of your Jewish birthday we need to know what time of day you were born.
Age
Grade Entering
Name of Child #2
DOB
Age
Grade Entering
Name of Child #3
DOB
Age
Grade Entering
Parent Information
Father's Name
Father's Address
Father's Phone
Father's Cell
Father's Email
Mother's Name
Mother's Address
Mother's Phone
Mother's Cell
Mother's Email
Emergency Information
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor's Name
Doctor's Phone Number
Medical Insurance Company
Policy Number

Have there been any changes in medical or any other pertinent information in the past 12 months? Yes No

If yes, please list changes




Registration Fee
THIS FORM IS FOR THE REGISTRATION FEE ONLY.
TUITION PAYMENTS CAN BE MADE CLICKING
HERE.
Registration Fee: $100
Tuition Payments can be made by clicking here
Method of payment:
Check
Credit Card
Other as arranged with the office.
Please mail checks to Chabad of Potomac Hebrew School, attn: Mrs. Sara Bluming, Director, 11826 Seven Locks Rd, Potomac MD 20854
Family Name
Child 1 $100 Registration Fee
Child 2 $100 Registration Fee
Child 3 $100 Registration Fee
Total Registration Cost:
Registration Payment
Refer a friend and save 10% per family! (Friend must be new to CHS and will be registering their child for CHS this coming year)
Name of Friend
CC Type Card Number
Billing Address City, State, Zip
Charge Amount Exp Date
CVV
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials: Date:

We look forward to a wonderful year of learning and growth!

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